Utilization Review (UR) Supervisor

Summary

Join Spectrum Billing Solutions, an industry-leading revenue cycle management company, as a Utilization Review (UR) Supervisor. This remote/hybrid position involves supervising and supporting the UR team, obtaining authorizations for behavioral healthcare services, and ensuring compliance with utilization review guidelines. You will develop training programs, handle escalations, review patient information, manage denials, and interact with insurance companies. The ideal candidate is passionate, motivated, and detail-oriented. Spectrum offers a close-knit team, growth opportunities, competitive salary, healthcare benefits, 401K, and flexible PTO.

Requirements

• 3-5 years of experience in utilization review for behavioral health services
• Bachelor’s or Master’s degree
• Superior written and oral communication skills
• Attention to detail to ensure necessary information is captured and properly documented
• Ability to work independently and within a team
• Ability to multi-task, prioritize and meet expected deadlines
• Solid understanding of insurance benefits and coverages
• Strong computer skills (Word, Excel, billing software)
• Understanding of mental and behavioral health treatment services

Responsibilities

• Provide planning, direction and priority setting for the UR team
• Assist with development and implementation of training programs, policies, guidelines, and processes
• Provide support to staff in handling escalations and/or issues
• Review patient admission and clinical information to ensure medical necessity and compliance of utilization review guidelines
• Obtain initial and continuing authorization for treatment services
• Manage authorization denials including referral for peer review
• Demonstrate the ability to make critical decisions about medical necessity of treatment by using good judgment
• Interact with insurance companies in a respectful, professional manner that facilitates the utilization review process and follows policies and procedures
• Document and record all necessary information
• Monitor and track new and ongoing authorization cases
• Collaborate and communicate with clinical staff to ensure necessary information is obtained and timely reviews are performed
• Assist the treatment team in understanding payer requirements for admission, continued stay and discharge planning
• Participate in team meetings and case conference reviews

Benefits

• A close-knit team of talented and skilled individuals
• Growth opportunities within the organization
• Competitive salary
• Healthcare benefits including medical, dental & vision
• 401K Plan
• Flexible PTO